Peninsula emergency room use has declined

The Affordable Care Act with its mandate that everyone must carry health insurance was expected to bring a dip in expensive emergency room use, the refuge of the uninsured for non-emergency treatment. The promise of reduced health care costs was part of the marketing surrounding health care reform.

While hospital systems on the Peninsula have all seen a decrease, their representatives maintain that it's still too early to measure the ACA's effect, as many insurance policies only became effective in April or May. All three — Riverside, Sentara and Bon Secours — noted that emergency room use started to drop last year, before the mandate, and the trend has continued into 2014.

Each attributed the drop to different causes.

"Insurance companies are trying to get people to choose wisely," said Lynne Zultanky of Bon Secours Hampton Roads, indicating that high-deductible charges for ER use — sometimes 10 times the amount charged at an urgent care facility — were steering patients away from emergency rooms. "People are becoming more cost-savvy," she added.

Bon Secours' ER visits dropped more than 5 percent last year and again at the beginning of 2014.

She also cited competition from new providers in the market and physicians' offices offering extended hours on evenings and weekends as affecting emergency room use. "It's hard to track where they didn't come from," Zultanky said, noting that the health system could only make educated guesses.

At Sentara, Rob Broermann, chief financial officer, attributed the health system's across-the-board 2 percent drop in ER use, which started last summer, to a relatively mild flu season and more robust use of primary care providers.

"The decreases are in lower acuity ER visits which indicate people are finding their way to PCPs," he said.

"It's the transformation of care through really aggressive management of primary care, having a health coach call on the phone, and better management of chronic diseases," added Dale Gauding, a spokesman for Sentara.

Like the others, use at Riverside's emergency rooms has also declined with visits in the first four months of 2014 down by 4 percent from the previous year. January visits saw the most significant drop from the previous year, down by almost 10 percent, offset by a marginal increase in February. Consistently, the numbers of insured patients seeking care in the ER declined each month, by an average of 7 percent, while there was a corresponding increase of 8 percent in uninsured visitors.

"The general rule of thumb still holds true," said Sentara's Broermann. "The uninsured population is going to run in the 17 to 20 percent range, about one in five or six ER patients. There's nothing in the longer-term trend that has skewed that."